To the editor:
It has come to my attention recently that my profession has come under fire by the Liberal government with the proposed changes in corporate tax laws. In this letter today, I offer another point of view that has been relatively quiet to this point.
This letter is my perspective as a resident physician training in Northern Ontario. For starters, my name is George McKay. I attended Lakehead University and am a recent graduate of the Northern Ontario School of Medicine. I am currently completing my residency in Thunder Bay, where I was born and raised. As a first year resident, I am just beginning my practice of medicine after eight years of post-secondary education. To offer a bit of history of what my colleagues and I have gone through in the journey to become a practicing physician, I will bring this back to the first couple of years of university. In Ontario, all students that wish to apply for a medical degree must first complete an undergraduate degree. For many of us, this can be a biology degree, a chemistry degree, or a nursing degree. Regardless, it is four years of schooling before medicine even becomes an option. Many individuals aspiring towards a career in medicine will not just require this degree as acceptance to medical school is extremely competitive. This means that certain individuals will also complete postgraduate education such as a master's degree (another 2 years), a PhD (another 2-4 years) or work experience before they will be considered for a program in medicine. However, obtaining a degree is not the only requirement for medical school. The majority of schools require the MCAT, a standardized medical school entrance exam that can take up to 8 hours to complete. A strong candidate should also be engaged in extracurricular activities, volunteer opportunities, and part-time employment, all while maintaining a 3.80 GPA (roughly an A average). If you present a competitive application, you may be selected from thousands of applications for an interview. Only a portion of the hundreds of students interviewed will be offered a position in medical school. There are 17 Canadian Medical schools in Canada with their own guidelines, but they are all quite similar to this description.
Most recently, the average age of acceptance was 26 years of age at the Northern Ontario School of Medicine, meaning that the average person will graduate medical school and start residency at the age of 30. This means that at the very minimum, a student in Ontario will complete eight years of education (i.e., four years of an undergraduate degree and four years of a medical degree, contingent on immediate acceptance into medical school). The average student completing 13 years of training after high school, and will be leaving this education with over $158,000 of debt from medicine alone. Following graduation, all physicians are required to complete a residency for specific training in a field of medicine. Residency programs will run anywhere from two to nine years depending on interests and specialties. For example, a cardiologist will complete six years or more of specialized training after medical school. The salary for a first-year resident is $57,967.29. The average hours a resident works per week ranges from 70-100 hours depending on peaks and discipline. Given a 70-hour workweek, the average salary per hour equates roughly to $15.90/hour. This is only $0.90 above what is soon to be the minimum wage in Ontario. Additionally, these numbers reflect the wages of a resident in 2017; many of my senior colleagues worked for significantly less money and increased hours in prior years.
There has been a great deal of commentary that physicians are replaceable, that they chose their profession knowingly, and that they are already overpaid. “You chose the profession, if you don’t like it then do something else”, or “stop complaining, you’re well overpaid”, or “go somewhere else, we can get replacements”. The way I see it, physicians are simply trying to fight as a group for what we feel is fair compensation. Many professions fight for what they feel is fair pay and treatment from their employers. They will use techniques like striking and raising public awareness. I applaud these acts, as you must fight for what you are passionate about. However, physicians are now using these tactics and we are considered complainers or easily replaceable. Large groups of people are claiming that physicians have resorted to scare tactics and are acting unethically when we are in fact. Standing up for what we believe in and what we feel is fair—much like other professions do. Would you not stand up against an employer who was trying to drastically reduce your profitability no matter what your take-home income might be? Would you not fight against these cuts in a time where you are being asked to work harder with a limit on time, while witnessing professions around you being rewarded with pay increases?
Yes, I was well aware of what I was signing up for: a delayed start to life, a delayed start to having a family, a career without benefits, or sick days. I was aware that residency would involve terrible pay and long work hours. I was not aware of unilateral pay cuts and a government attack in a time where costs and the salaries of others are increasing. However, with the continued cuts and actions of the government, it has many of us wondering whether this road is really worth it. Are all the risks that come with being a physician worth it? Would it not be easier to pursue a stable career that requires half the time spent training, comes with benefits, that is not under attack from the government and that has witnessed increasing pay scales to inflation rates? I ask myself now, as a first-year resident, whether my time and work could have been better utilized in a different career path. Currently, in northern Ontario our accessibility to healthcare resources is quite scarce with the current healthcare format and is likely to feel the effects of such drastic measures by the liberal government. Northwestern Ontario currently has no practicing dermatologist. Thunder Bay has an estimated 20-30 thousand residents without a primary care physician. It is the emergency department and inpatient services that are trying to keep up with an aging population in the setting of limited healthcare resources. An estimated 25 per cent of TBRHSC admission is orphaned patients.
When I decided to pursue a career in medicine, I wanted to be able to help those in need, to give back to my community that has given me so much throughout my life, to bring life into this world, and to possibly one day help to make some life-altering and life-saving decisions. I have written this letter to you today to provide the perspective of a resident in Northern Ontario about what I find is becoming an unpalatable situation in Canadian healthcare. Although my goals have always been to serve my community and those around me, the current incentives or lack thereof and unilateral actions of our government are having me second guess where I will practice in my future, and with this, I am sure there have been many others with this thought process.
George McKay, MD
